Try Compromise And Let Health Plan

Have Chance To Succeed On Merits

March 23, 1994

Florida's new health care plan relies on the private sector through "managed competition" and obviously is an experiment, untried and unproved on a large scale. No one can guarantee this health reform's success or accurately predict its failure, but the plan certainly shows enough promise to be given a fair chance.

In Tallahassee, the health plan is being assailed from several sides, with opponents hoping to cripple it by inflicting multiple small cuts. Three specific attacks are gaining ground in the Legislature, as lobbyists push for their own interests.

One inhumane assault from insurance companies is based on their refusal, usually, to write health policies at reasonable premium rates for anyone who isn't healthy. As Insurance Commissioner Tom Gallagher pointed out sharply, this must change.

Insurers persuaded House Speaker Bo Johnson to bottle up a bill requiring them to offer individual health policies at the same basic price to all comers, no matter their medical condition. The bill will die unless public-spirited legislators intervene.

Another watering down involves a benefit package for health policies. The original package, which stressed preventive measures to keep Floridians healthy, was cut back in the House.

As it stands, patients would have to pay more for each visit to the doctor and wouldn't be covered for brand prescriptions or substance abuse treatment. The benefits package was worked out by physicians after public hearings, and diluting it will make health reform less likely to work.

The most publicized attack against the health plan is coming from the Florida Medical Association, on an issue called "any willing provider."Hitting a hot button by saying a patient should have freedom of choice to see any doctor, the FMA is trying to change the way health maintenance organizations operate.

It's a complex argument, with hyperbole on both sides, but a promising compromise is on the table. Right now, a bill says this: A patient who signs up with an HMO could see any doctor, if the "willing" physician accepts a fee that is 95 percent of the HMO's regular payment to its affiliated doctors. The patient would pay 5 percent.

A compromise would allow patients to see doctors outside the HMO's approved list by paying a higher premium to the HMO. This looks promising.

Overheated rhetoric should be cooled. The FMA is acting as if HMOs will be the only kind of health arrangement available under the Florida plan. That's not so; more traditional approaches can be chosen.

State health officials contend opening up HMOs to any doctor will destroy reform. That's not so, if rational thinking is applied, as in the proposed compromise.

Florida's health plan is supported by big and small business because it's voluntary. No business will be compelled to join, but if the reform works, smart business owners will realize it's in their best interest to offer affordable health insurance to employees.

On May 1, Florida will start enrolling members in regional purchasing alliances for health insurance. Let it begin. Give it a chance to succeed or fail, on its merits.